The Alcohol Environment Protocol: A new tool for alcohol policy

Abstract

Introduction and AimTo report data on the implementation of alcohol policies regarding availability and marketing, and drink driving, along with ratings of enforcement from two small high‐income to three high‐middle income countries, and one low‐middle income country.MethodThis study uses the Alcohol Environment Protocol, an International Alcohol Control study research tool, which documents the alcohol policy environment by standardised collection of data from administrative sources, observational studies and interviews with key informants to allow for cross‐country comparison and change over time.ResultsAll countries showed adoption to varying extents of key effective policy approaches outlined in the World Health Organization Global Strategy to Reduce the Harmful Use of Alcohol (2010). High‐income countries were more likely to allocate resources to enforcement. However, where enforcement and implementation were high, policy on availability was fairly liberal. Key Informants judged alcohol to be very available in both high‐ and middle‐income countries, reflecting liberal policy in the former and less implementation and enforcement and informal (unlicensed) sale of alcohol in the latter. Marketing was largely unrestricted in all countries and while drink‐driving legislation was in place, it was less well enforced in middle‐income countries.ConclusionIn countries with fewer resources, alcohol policies are less effective because of lack of implementation and enforcement and, in the case of marketing, lack of regulation. This has implications for the increase in consumption taking place as a result of the expanding distribution and marketing of commercial alcohol and consequent increases in alcohol‐related harm.

Availability of alcohol: Location, time and ease of purchase in high‐ and middle‐income countries: Data from the International Alcohol Control Study

“…Alcohol was easily accessible in the countries participating in the current study. The majority of drinkers, or close to, reported that they usually accessed alcohol in 5 min or less and likely reflects the high availability of alcohol reported previously in all of these countries .…”

“…The only exception was St Kitts and Nevis, a country which had transitioned to high‐income by 2014 , where access was very easy for those under the purchase age. These findings likely reflect the lack of enforcement of the purchase age in reported in these countries .…”

Policy‐relevant behaviours predict heavier drinking and mediate the relationship with age, gender and education status: Analysis from the International Alcohol Control Study

“…Prevalence of drinking alcohol is approximately related to per capita income but there are exceptions, for example, Thailand where the prevalent religion and the government's implementation of effective alcohol control policy have maintained lower prevalence. In middle‐income countries, lower levels of policy enforcement are common .…”

Commentary on White et al. (2018): Decrease in adolescent drinking linked to direct and indirect effect of alcohol control policies

“…The extent to which this reflects controls on youth's direct purchase versus social supply are not investigated here and, as the authors point out, implementation measures (enforcement and compliance) are not included in the study. Australia, a high‐income country, is likely to have good implementation compared with middle‐income countries , particularly in relation to purchase age. However, social supply is known to be a particularly difficult area to enforce, partly because it takes place in private settings, and further research to identify differential effects would be valuable.…”